Doctor John Snow and the
1854 Soho cholera epidemic

The Cholera Pump

Cholera is a deadly disease spread
through poor sanitation.
Several continental-scale pandemics struck in the 1800s,
killings millions across Asia, Europe, and the Americas.
Doctor John Snow discovered during the
1854 outbreak in London that the disease was being spread
by a public water pump in the Soho area.
His discovery was an early example of
epidemiology.
He disabled the pump and stopped the outbreak, but it took
several years for medical science to catch up with Snow's
insight.
A pub named in his honor stands nearby today.

Cholera

Cholera is a bacterial intestinal infection causing
profuse watery diarrhea, vomiting, fever and abdominal pain.
The severity of the diarrhea and vomiting can quickly lead
to dehydration and electrolyte imbalance.
Infection is usually through drinking water contaminated by
the watery diarrhea, colloquially called "rice-water stool".

Cholera is a major cause of death world-wide,
outside developed countries with advanced water treatment
and sanitation.
The last major outbreak in the United States was in 1910-1911.

The first cholera pandemic was in 1816-1826.
The disease began spreading in Bengal, in the Indian
subcontinent.
By 1820 it had spread across India, killing 10,000 British
troops and many times that number of Indians.
The outbreak spread as far as China, Indonesia, and the
Caspian Sea basin.
An estimated 15 million people died in India between 1817
and 1860, and another 23 million between 1865 and 1917.

The replica Broad Street Pump in Soho, with the John Snow
pub in the background.

The second cholera pandemic was in 1829-1851,
reaching Russia, Hungary, and Germany in 1831,
and London and Paris in 1832.
6,536 victims died in London, and the bacteria was established
in Britain.

There was a second major outbreak in Paris and London
in 1849.
London's outbreak killed 14,137.
It also spread to other British cities, and by ships to North
America.
Several thousand died in the U.S., including former U.S.
President James Polk.
Over 150,000 Americans and 200,000 Mexicans died during
the pandemics between 1832 and 1849.

The Painted Veil
contains striking depictions of rice-water stool in a cholera
pandemic in south-eastern China in the 1920s.
Author W. Somerset Maugham was a physician who spent lots
of time in south-east Asia and the Pacific.
The film was shot in
Guangxi Province — click here
for pictures from my trip there.
I had no rice-water stool, though.

The Ghost Map
by Steven Johnson
describes the history of cholera, Snow, and his analysis.

Further outbreaks in 1853-1854 killed about
3,500 people in Chicago (5.5% of the city's population)
and 10,738 in London.

The 1854 London Cholera Outbreak

The 1854 outbreak in London was centered on the Soho area.
Doctor John Snow analyzed the available
information and determined that the main agent spreading
cholera was a public water pump on Broad Street.
The spring below the pump had been contaminated by sewage.
Snow didn't know what the contaminant was, but he found that
the common attribute of victims was the use of water from
that pump.
Snow's analysis was one of the first examples of
epidemiology.
Despite objections, he convinced the government officials
to remove the pump's handle.

This change stopped that outbreak,
but it took many more years before there was wide belief
in contaminated water as the cause.
"Miasma" or "bad air" was the preferred explanation.
The government officials replaced the handle on the
contaminated pump after the pandemic had subsided.

Accepting Snow's explanation required accepting the
fecal-to-oral transmission of disease, which they thought
was too unpleasant for the public (although they seemed to
think that the public could handle cholera itself just fine).

The above picture shows a replica pump unveiled in 1992.
Things have changed quite a bit in Soho since the 1850s.
The pump was at the intersection of Broad Street and
Cambridge Street — now renamed Broadwick Street
and Lexington Street, respectively.
It was close to the rear wall of today's
John Snow pub, named in honor of
the pioneering epidemiologist.

The John Snow Pub

You can see the John Snow pub beyond the replica
de-handled pump in the picture above.
Here and below are some pictures from inside on a
quiet mid-week night.

Interior of the John Snow Pub.

The John Snow is a Samuel Smith's pub,
meaning that it only sells beer from that one brewery.
It is kegged beer, dispensed through taps, and not
hand-pumped from basement casks.
You can see those illuminated taps along the bar but
not long pump handles.

So purists would say that it's not a "real beer pub".
But it's a popular place in the neighborhood with
low prices, a friendly atmosphere, some wonderful old
architecture, and it's a nice place for a pint.

There is a very low pass-through door between the left
and right halves of the pub.

Sinks and large urinal in the Gents' room.

Snow's Analysis

Snow used statistics and careful mapping of cholera cases
to show that the Southwark and Vauxhall Waterworks Company
was delivering sewage-contaminated water from the Thames
river to homes, leading to an increase in the number of
cholera cases.
Many families tried to have their raw sewage collected
and dumped into the Thames to keep they cesspit from
filling faster than their septic waste could decompose
and be absorbed into the soil.
He then showed that there was a cluster of cholera cases
around this pump.

Later research showed that this public well had been dug
only three feet from an old cesspit which was
leaking fecal bateria.
The soiled diapers of a baby who had contracted cholera
from another source, possibly the contaminated water
delivered by the Southwark and Vauxhall Waterworks Company,
had ended up in this cesspit.
That cesspit was originally under a house, which had been
rebuilt in a different location after a fire.
The city widened the street and lost track of the cesspit,
and later the well was sunk just an arm's reach away.

Doctor John Snow's cholera map, by which he traced
the origin of the 1854 Soho cholera outbreak to the pump.

Snow wrote a letter to the editor of the
Medical Times and Gazette —

On proceeding to the spot, I found that nearly all the deaths
had taken place within a short distance of the [Broad Street]
pump. There were only ten deaths in houses situated decidedly
nearer to another street-pump. In five of these cases the
families of the deceased persons informed me that they always
sent to the pump in Broad Street, as they preferred the water to
that of the pumps which were nearer. In three other cases, the
deceased were children who went to school near the pump in Broad
Street...

With regard to the deaths occurring in the locality belonging to
the pump, there were 61 instances in which I was informed that
the deceased persons used to drink the pump water from Broad
Street, either constantly or occasionally...

The result of the inquiry, then, is, that there has been no
particular outbreak or prevalence of cholera in this part of
London except among the persons who were in the habit of
drinking the water of the above-mentioned pump well. I had an
interview with the Board of Guardians of St James's parish, on
the evening of the 7th inst [7 September], and represented the
above circumstances to them. In consequence of what I said, the
handle of the pump was removed on the following day.

These public health concerns have led to modern
standards for hot water temperature, and thus
to further worries about potential injuries.

My cromwell-intl.com domain appeared in September, 2001,
although the Wayback Machine didn't notice its one enormous
Toilet of the World page until
January 17, 2002.
Some time soon after that I split it into categories,
and the collection has grown ever since.

In December, 2010 I registered the
toilet-guru.com
domain and moved the pages to a dedicated server.